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Membership Application

Submit application and check made out to NDPC to: Pam Knudson, NDPC First Vice President, 501 N. Columbia Rd., Grand Forks, ND 58201.

Name:

Home Address:

Home Telephone:

Employer:

Office Address:

Office Telephone:

Fax:

E-mail Address:

Job Title / Position:

Work Experience:

Education:

What do you expect from NDPC?

Signature:

Date:

Recommended by:

I have enclosed a check for $____

Membership level: